Exhaled breath compositions under varying respiratory rhythms reflects ventilatory variations: translating breathomics towards respiratory medicine.

Control of breathing is automatic and its regulation is keen to autonomic functions. Therefore, involuntary and voluntary nervous regulation of breathing affects ventilatory variations, which has profound potential to address expanding challenges in contemporary pulmonology. Nonetheless, the fundamental attributes of the aforementioned phenomena are rarely understood and/or investigated. Implementation of unconventional approach like breathomics may leads to a better comprehension of those complexities in respiratory medicine. We applied breath-resolved spirometry and capnometry, non-invasive hemodynamic monitoring along with continuous trace analysis of exhaled VOCs (volatile organic compounds) by means of real-time mass-spectrometry in 25 young and healthy adult humans to investigate any possible mirroring of instant ventilatory variations by exhaled breath composition, under varying respiratory rhythms. Hemodynamics remained unaffected. Immediate changes in measured breath compositions and corresponding variations occurred when respiratory rhythms were switched between spontaneous (involuntary/unsynchronised) and/or paced (voluntary/synchronised) breathing. Such changes in most abundant, endogenous and bloodborne VOCs were closely related to the minute ventilation and end-tidal CO exhalation. Unprecedentedly, while preceded by a paced rhythm, spontaneous rhythms in both independent setups became reproducible with significantly (P-value ≤ 0.005) low intra- and inter-individual variation in measured parameters. We modelled breath-resolved ventilatory variations via alveolar isoprene exhalation, which were independently validated with unequivocal precision. Reproducibility i.e. attained via our method would be reliable for human breath sampling, concerning biomarker research. Thus, we may realize the actual metabolic and pathophysiological expressions beyond the everlasting in vivo physiological noise. Consequently, less pronounced changes are often misinterpreted as disease biomarker in cross-sectional studies. We have also provided novel information beyond conventional spirometry and capnometry. Upon clinical translations, our findings will have immense impact on pulmonology and breathomics as they have revealed a reproducible pattern of ventilatory variations and respiratory homeostasis in endogenous VOC exhalations.